The MMPI-3 is the third edition of the Minnesota Multiphasic Personality Inventory, a psychological self-report test used to evaluate a wide range of mental health conditions and personality traits. It consists of over 350 true/false questions and provides scores on validity, clinical, and personality scales.
Five scales detect feigned mental disorders, yield information relevant for differential diagnosis, indicate the therapeutic prognosis, and unveil personality characteristics predictive of psychosocial functioning.
Compared to previous versions, MMPI-3 was updated to have better psychometric properties and capture a wider range of psychiatric conditions listed in the DSM-5.
Bryant, W. T., Livingston, N. A., McNulty, J. L., Choate, K. T., Santa Ana, E. J., & Ben-Porath, Y. S. (2024). Exploring the Minnesota Multiphasic Personality Inventory (MMPI)-3 in a transgender and gender diverse sample. Psychological Assessment, 36(1), 1–13. https://doi.org/10.1037/pas0001287
Key Points
- The study examined the psychometric properties of the MMPI-3 in a sample of 97 transgender and gender-diverse (TGD) individuals.
- Reliability and validity evidence supported the use of the MMPI-3 with TGD individuals.
- Comparisons were made between TGD subgroups, the MMPI-3 normative sample, and a clinical sample.
- TGD individuals not in mental health treatment scored higher than the normative sample on several scales assessing emotional difficulties.
- TGD individuals in mental health treatment scored substantially higher than TGD individuals not in treatment, likely reflecting their clinical status.
- Scores of TGD individuals in treatment were largely similar to the clinical sample, except for elevated suicide risk.
Rationale
Previous research on transgender and gender-diverse (TGD) mental health has relied almost exclusively on screening measures rather than comprehensive assessments of personality and psychopathology like the Minnesota Multiphasic Personality Inventory (MMPI; Hathaway & McKinley, 1943) family of tests (Bryant et al., 2021).
Studies using older MMPI versions with TGD samples found the Masculinity-Femininity scale was often elevated, but evidence for other Clinical Scale elevations was mixed (Caron & Archer, 1997; Greenberg & Laurence, 1981; Miach et al., 2000).
The most recent investigation using the MMPI-2-Restructured Form (MMPI-2-RF; Ben-Porath & Tellegen, 2008) with TGD individuals provided initial evidence that MMPI-2-RF scores could reflect mental health challenges experienced by this group (Bryant et al., 2021).
However, the MMPI-2-RF norms were collected over 30 years prior to the TGD data. The present study replicated this prior work to address potential cohort effects using the newly released MMPI-3 (Ben-Porath & Tellegen, 2020a) and concurrent samples.
Method
The total TGD sample consisted of 97 TGD adults who completed the MMPI-2-RF-Expanded (MMPI-2-RF-EX) booklet. This measure includes all MMPI-2-RF and MMPI-3 test items, allowing MMPI-3 scale scores to be derived.
Thirteen additional participants were excluded for producing technically invalid MMPI protocols. Participants were recruited throughout the Midwest and Southwest United States.
Materials included the MMPI forms and criterion measures of impulsivity, anxiety, depression, unusual beliefs, posttraumatic symptoms, and resilience.
MMPI-3 scores were compared for reliability across the total TGD sample, normative sample (N = 1,620), and an outpatient clinical sample (N = 315).
Sample
The TGD sample was 36 years old on average. Most participants identified as transgender female (53%) or transgender male (26%),
White (77%), and having at least some college education (80%). Fifty TGD individuals were not in mental health treatment, and 47 were currently in treatment.
The MMPI-3 normative sample (N = 1,620) was demographically matched to 2020 U.S. Census projections. The clinical sample (N = 315) consisted of mental health outpatients from a community mental health center.
Statistical Measures
Reliability was examined via Cronbach’s alpha. Validity was evaluated by testing differences between absolute values of convergent versus discriminant correlations using one-tailed z-tests of independent correlations.
Mean differences were tested with independent samples t-tests, using Hedges’ g as the effect size measure.
Results
The MMPI-3 scales showed similar reliability when given to transgender individuals versus the general population. This means the test was measuring psychological constructs consistently across these groups.
When looking at validity – whether the test accurately captured mental health difficulties transgender people face – the MMPI-3 scales largely worked as expected. Scales tied to issues like anxiety, depression, and trauma correlated with separate measures of those problems in transgender individuals.
Transgender people not currently getting mental health treatment scored higher on several MMPI-3 scales related to emotional problems compared to the general public (they showed far higher suicide risk).
Transgender patients already in mental health treatment scored much higher than transgender people not in treatment on scales covering feelings of depression, anxiety, hopelessness, and more. This matches the expectation that seeking treatment signals greater distress.
Sores for transgender mental health patients were very close to scores for cisgender patients on almost all scales – except transgender individuals showed higher suicide risk even when in treatment. So this ongoing elevated risk seems uniquely tied to their gender minority status.
Insight
This investigation demonstrates initial evidence that the MMPI-3 functions similarly in TGD versus cisgender samples.
Reliability results suggest the MMPI-3 is consistently measuring its intended constructs when administered to TGD individuals. Validity findings provide preliminary support that expected psychological difficulties can be detected among TGD persons.
Additionally, the heightened emotional distress found in non-treatment-engaged TGD persons relative to the general population aligns with previous findings of health disparities faced by gender minorities.
The substantially greater dysfunction observed among TGD individuals in mental health treatment likely reflects their clinical status. It was concerning that suicide risk, as measured by the Suicidal/Death Ideation scale, was comparably elevated in TGD persons regardless of their engagement with mental health services relative to mostly cisgender clinical participants.
Overall, this investigation sets the foundation for additional research establishing the MMPI-3 as an assessment tool that can identify areas of psychopathology to address when working with TGD clients to provide culturally-informed treatment.
Strengths
- Using the updated MMPI-3 allowed for unconfounded comparisons to newly collected normative and clinical samples.
- Recruiting a community sample of TGD individuals for this initial psychometric investigation was a strength given most prior studies utilized TGD persons already approved for clinical services.
- Establishing reliability evidence before evaluating aspects of validity bolstered the interpretation of correlations between MMPI-3 and criterion measures.
Limitations
- The predominantly White, educated sample limits the generalizability of these findings to more diverse TGD populations.
- Additional research is needed to demonstrate the measurement invariance of MMPI-3 scale functioning in TGD versus cisgender groups.
- More comprehensive evaluations using a wider range of psychopathology criterion measures would provide stronger validity evidence of MMPI-3 scales in TGD samples.
Implications
This study has meaningful implications for psychological practice by providing preliminary support for utilizing the MMPI-3 to identify sources of pathology when working with TGD clients.
Given findings of heightened emotional difficulties and suicide risk among TGD individuals versus norms and clinical samples, directing attention to internalizing problems and suicidality when formulating treatment plans for TGD clients seems especially warranted based on this investigation.
The MMPI-3 scales displaying the largest elevations in the TGD clinical subsample compared to norms also denote specific areas of dysfunction that could be addressed through targeted interventions. These encompassed demoralization, hopelessness, self-doubt, anxiety, social introversion, and family problems.
Additionally, these results carry relevance for policy and healthcare systems by demonstrating the utility of established assessment measures like the MMPI-3 for identifying mental health needs in minority populations. This study thus helps make the case for coverage and implementation of assessments to inform the treatment of TGD individuals.
References
Primary reference
Bryant, W. T., Livingston, N. A., McNulty, J. L., Choate, K. T., Santa Ana, E. J., & Ben-Porath, Y. S. (2024). Exploring the Minnesota Multiphasic Personality Inventory (MMPI)-3 in a transgender and gender diverse sample.Psychological Assessment, 36(1), 1–13. https://doi.org/10.1037/pas0001287
Other references
Ben-Porath, Y. S., & Tellegen, A. (2008). Minnesota Multiphasic Personality Inventory-2-Restructured Form: Manual for administration, scoring, and interpretation. University of Minnesota Press.
Ben-Porath, Y. S., & Tellegen, A. (2020a). Minnesota Multiphasic Personality Inventory-3 (MMPI-3): Manual for administration, scoring, and interpretation. University of Minnesota Press.
Bryant, W. T., Livingston, N. A., McNulty, J. L., Choate, K. T., & Brummel, B. J. (2021). Examining Minnesota Multiphasic Personality Inventory-2-Restructured Form (MMPI-2-RF) scale scores in a transgender and gender diverse sample. Psychological Assessment, 33(12), 1239-1246. https://doi.org/10.1037/pas0001087
Caron, G. R., & Archer, R. P. (1997). MMPI and Rorschach characteristics of individuals approved for gender reassignment surgery. Assessment, 4(3), 229-241. https://doi.org/10.1177/107319119700400303
Greenberg, R. P., & Laurence, L. (1981). A comparison of the MMPI results for psychiatric patients and male applicants for transsexual surgery. Journal of Nervous and Mental Disease, 169(5), 320–323. https://doi.org/10.1097/00005053-198105000-00010
Hathaway, S. R., & McKinley, J. C. (1943). The Minnesota Multiphasic Personality Inventory. University of Minnesota Press.
Miach, P. P., Berah, E. F., Butcher, J. N., & Rouse, S. (2000). Utility of the MMPI-2 in assessing gender dysphoric patients. Journal of Personality Assessment, 75(2), 268-279. https://doi.org/10.1207/S15327752JPA7502_7
Keep Learning
Here are some suggested discussion questions for a college class:
- Can psychological assessments developed and normed on cisgender populations, like the MMPI-3, be appropriately adapted for use with transgender and gender-diverse persons? What challenges or biases may emerge? What best practices should be followed?
- What might explain the observed mental health disparities between the transgender subsample not receiving mental health treatment and the general population as represented by the MMPI-3 normative sample? How might minority stress factors uniquely impact this group?
- The study found the treatment-seeking transgender subsample scored very similarly to the outpatient clinical group, except for heightened suicide risk. What implications does this have for suicide risk assessment, prevention, and intervention when working with transgender clients compared to cisgender clients?
- What multiculturally informed adaptations to assessment and treatment might better serve transgender clients based on the findings of studies like this one? What perspectives should be considered and integrated?
- The study samples were predominantly white and educated. How might results differ with more diversity along lines of race, ethnicity, socioeconomic status, age, and gender identity subgroups? What barriers to accessing clinical services might some subgroups face?
